Delaware County Gaels - LeagueAthletics.com
2012 SUMMER CAMP REGISTRATION Player(s) Information Name:___________________________ D.O.B: ___ /___ /___ Address:____________________________________ City:_________________________________ State: _____
ZIP: ____________
Phone: (______) ______________________ Email: ___________________________________ Checks should be made payable to: “Delaware County Gaels”
Registration Deadline: -
June 23, 2012 (Camp 1)
/ July 14, 2012 (Camp 2)
Camp open to ALL children aged 5-14. No knowledge of Gaelic Football or Hurling needed to participate.
Health Insurance Insurance Company: _________________________________ Policy: _________________________________ ID No.
____________________________
Emergency Emergency Contact Name: _________________________ Emergency Contact Number: (______) ______________
Parent/Guardian Agreement I, the parent/guardian of the registered player, a minor, agree that the player and I will abide by the rules of the North Am erican County Board, and its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with Gaelic football and in consideration for the Delaware County Gaels Football Club accepting the player for their programs and activities, I hereby release, discharge and/or otherwise indemnify The Delaware County Gaels Football Club, their affiliated organizations and sponsors, board members and associated personnel, including the owners of fields and facilities utilized for the programs, against any claim by or on behalf of the registrant as a result of the registrant's participation in the programs and/or being transported to or from the same, which transportation I hereby authorize. I intend for this consent and agreement to be legally enforceable.
Parent/Legal Guardian (Please Print): _________________________________ Signature: _________________________________ Date: ____/_____/_______ Consent for Medical Treatment As the parent/legal guardian of a participant in The Delaware County Gaels Football Club, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever condition s are necessary to preserve the life, limb or well-being of my dependent.
Signature: _________________________________ Date: ____/_____/_______ Please mail completed form and fee to: Ciaran Porter 1510 Darby Road Havertown, PA 19083
[email protected]
ZIP: ____________
Phone: (______) ______________________ Email: ___________________________________ Checks should be made payable to: “Delaware County Gaels”
Registration Deadline: -
June 23, 2012 (Camp 1)
/ July 14, 2012 (Camp 2)
Camp open to ALL children aged 5-14. No knowledge of Gaelic Football or Hurling needed to participate.
Health Insurance Insurance Company: _________________________________ Policy: _________________________________ ID No.
____________________________
Emergency Emergency Contact Name: _________________________ Emergency Contact Number: (______) ______________
Parent/Guardian Agreement I, the parent/guardian of the registered player, a minor, agree that the player and I will abide by the rules of the North Am erican County Board, and its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with Gaelic football and in consideration for the Delaware County Gaels Football Club accepting the player for their programs and activities, I hereby release, discharge and/or otherwise indemnify The Delaware County Gaels Football Club, their affiliated organizations and sponsors, board members and associated personnel, including the owners of fields and facilities utilized for the programs, against any claim by or on behalf of the registrant as a result of the registrant's participation in the programs and/or being transported to or from the same, which transportation I hereby authorize. I intend for this consent and agreement to be legally enforceable.
Parent/Legal Guardian (Please Print): _________________________________ Signature: _________________________________ Date: ____/_____/_______ Consent for Medical Treatment As the parent/legal guardian of a participant in The Delaware County Gaels Football Club, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever condition s are necessary to preserve the life, limb or well-being of my dependent.
Signature: _________________________________ Date: ____/_____/_______ Please mail completed form and fee to: Ciaran Porter 1510 Darby Road Havertown, PA 19083
[email protected]
